A new early intervention program, financed with $88 million in federal health-reform money, has the potential of breaking the poverty cycle that afflicts generation after generation of at-risk families. The idea is to give a needy kid a healthy start in life through a home-visit  program that addresses child protection, health, early education and social service issues through age 8.

Local child advocates like Rich Patton, head of Vision for Children at Risk, welcomes this approach. He says Missouri does not invest nearly enough in the well-being of its children. For Patton, at least, the issue is a no-brainer. He says larger upfront investments in children would put the brakes on expensive emergency room visits and pay dividends down the road by heading off costly preventable problems, ranging from preterm births to violent behavior.

Illustration from the National Institutes of Health

The federal program is among the health-reform initiatives that the Obama administration hopes will show the public some of the benefits of the Patient Protection and Affordable Care Act -- a challenge that has taken on added urgency in the wake of the success of Proposition C, the state referendum in which Missouri voters became the first in the nation to object to at least one provision of the act.

On Tuesday, more than 71 percent of voters backed the referendum's language that Missouri should opt out of the federal health law's requirement that all adults have health insurance or pay a penalty. The outcome shows how much work the Obama administration has to do if they are to sell the public on mandating a product, health insurance, that everyone needs and thousands of Missourians do not have. The administration's task has become more difficult as the opposition frames the issue into a debate over federal mandates and states' rights.

Opponents say that the referendum succeeded in part due to a low voter turnout, and they note that the measure didn't win in St. Louis and Kansas City. Even so, proponents of Prop C hope the outcome will give rise to a groundswell of public support nationwide for rolling back health reforms. The next big tests of that premise will come in Arizona and Oklahoma, where voters will express their views in ballot initiatives in the November general election.

Proposition C proponents believe their victory in Missouri will be repeated in other states. But health reform supporters are just as forceful in arguing that the public is likely to embrace the Affordable Care Act as more of its benefits begin reaching the uninsured and the underinsured. At any rate, what happens at the polls is expected to have no immediate bearing on health reforms. The home-visit program is just one of many provisions that are beginning to take shape.

Nearly two weeks before the election, federal officials announced that Missouri would get $1.5 million in planning money to assess the needs for home visits and seek funding later for evidence-based models for helping children. The evidence-based approach is what's new about this program. It offers a response to critics who might say Washington tends to throw money at programs that don't solve problems. But evidence-based remedies are supposed to be grounded in science, tested and shown to be effective for addressing a given problem.

Kendra Copanas, executive director of St. Louis' Maternal, Child and Family Health Coalition , says this requirement raises the bar of what local programs must do to justify federal funding. She's excited about the new federal home visiting program, noting that it could make a difference in the long term because providers will work with at-risk children through age 8.

While the home visiting program is only in the planning stages, other health reform initiatives are up and running:

Uninsured With Pre-existing Conditions

An $81.3 million federal award has allowed Missouri to set up a short-term health insurance pool to make coverage more affordable for certain uninsured residents with pre-existing medical conditions. An estimated 3,000 Missourians are expected to join the pool through 2013, says Travis Ford, communications director for the Missouri Department of Insurance. That program provides short-term relief to at least some uninsured Missourians until the full force of the Affordable Care Act takes effect in 2014.

Coverage for Young Adults

Starting on Sept. 23, young people will be able to continue getting coverage through their parents' health insurance policies up to age 26. The Obama administration says this program will be a relief to roughly 20,000 young adults in Missouri who get health insurance coverage through their parents.

Small Business Tax Credit

The administration also says an estimated 94,300 small business owners in Missouri are eligible for a tax credit to offset insurance premiums. Some merchants argue that the program won't help them save money; others welcome it as an important step toward insurance relief. Under the program, small businesses with no more than 25 workers and average wages of less than $50,000 are offered tax credits up to 35 percent of the health insurance premiums.

The White House also has pointed to relief that health reforms are bringing to about 82,100 Missouri Medicare beneficiaries who are hurt by the so-called doughnut hole or gap in Medicare Part D drug coverage. This summer, under the Affordable Care Act, seniors affected by the doughnut hole have been receiving one-time rebate checks of $250 to offset this expense.

Coverage for Early Retirees

In this decade, early retirement has become more common, with no guarantee that the retirees will be able to take their health benefits with them, and they may be too young to qualify for Medicare health insurance. That is the experience of an estimated 82,000 Missouri residents, the administration says. As of June of this year, the Affordable Care Act has tried to soften the blow nationwide through a $5 billion temporary early retiree reinsurance program. It seeks to help companies, unions, and state and local governments provide health coverage to their early retirees.

More Consumer Protection

Also beginning on Sept. 23, the health-reform law will forbid insurers from excluding children with certain pre-existing conditions, and impose tighter regulations on an insurance plan's use of annual limits on benefits. The idea is to make sure policyholders get access to care when they need it, the administration argues. It adds that these rules not only protect 3 million Missouri residents who get health insurance through their job but offer help to any Missourians signing up for a new insurance plan.

Health Center Expansion

Come Oct. 1, the new law is expected to begin offering additional spending that will eventually double the number of people using community health centers. The administration expects this money to not only bolster the capabilities of the 180 community health centers in Missouri but also support the construction of new centers. Local planners note that the federal government has yet to decide how much health center money Missouri will get.

Money for More Doctors

One project that some area health centers and hospitals are excited about involves $1.5 billion that the health reform law will spend over five years for the National Health Service Corps. This money will cover scholarships and loan repayments for doctors, nurses and other health care providers who work in areas having a shortage of health professionals.

The loan repayment program will give some doctors an incentive to go into family medicine rather than higher-paying specialties that some medical students now pursue partly to help repay school loans. The administration says this new funding will bring care closer to an estimated 19 percent of Missourians living in medically underserved communities.